{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T17:58:10Z","timestamp":1760551090603,"version":"3.37.3"},"reference-count":9,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"2","license":[{"start":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T00:00:00Z","timestamp":1589241600000},"content-version":"vor","delay-in-days":72,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n Differentiating between a urinary tract infection and asymptomatic bacteriuria is an important distinction to make, especially in noncommunicative patients. An algorithm meant to aid in the diagnosis and treatment of urinary tract infections in this population was implemented within a psychiatric emergency department in January 2019. The primary objective of this project was to assess the impact of the algorithm (the intervention) regarding symptom documentation and antibiotic use. Secondary objectives included assessing changes in inappropriate prescribing and urine culture orders.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Preintervention outcomes were measured from August 1, 2018, through November 30, 2018, while the postintervention cohort included patients admitted after January 31, 2019 and discharged before June 1, 2019. Adults admitted to psychiatry with a urinalysis ordered in the emergency department and an ICD-10 code representing dementia, delirium, autism spectrum disorder, or intellectual disability were included; pregnant patients were excluded.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The preintervention (n\u2009=\u200956) and postintervention (n\u2009=\u200934) cohorts were well balanced with an average age of 66.5 and 70 years, respectively. Neurocognitive disorder was the diagnosis for inclusion in approximately two-thirds of both groups. Numerically, postalgorithm implementation, symptoms were documented more frequently (20.6% vs 10.7%, P\u2009=\u2009.23) and antibiotics used less often (2.9% vs 14.3%, P\u2009=\u2009.15). Inappropriate prescribing occurred in 12.5% of preintervention cohort compared to no patients postintervention (P\u2009=\u2009.04).<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n The creation and implementation of an algorithm assisting in the diagnosis and treatment of urinary tract infections in noncommunicative patients was associated with a trend toward increased symptom documentation and decreased overall antibiotic use, and significantly increased appropriate antibiotic prescribing.<\/jats:p>\n <\/jats:sec>","DOI":"10.9740\/mhc.2020.03.055","type":"journal-article","created":{"date-parts":[[2020,3,30]],"date-time":"2020-03-30T13:57:05Z","timestamp":1585576625000},"page":"55-59","source":"Crossref","is-referenced-by-count":4,"title":["Impact of a urinary tract infection diagnostic and treatment algorithm for psychiatric inpatients with a communication barrier"],"prefix":"10.9740","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8906-9332","authenticated-orcid":false,"given":"Christine","family":"Rarrick","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1604-9338","authenticated-orcid":false,"given":"Hannah","family":"Leschorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2179-2487","authenticated-orcid":false,"given":"Amy","family":"Hebbard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4719","reference":[{"issue":"1","key":"2020060309441619000_i2168-9709-10-2-55-b01","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1111\/jgs.12070","article-title":"Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections","volume":"61","author":"D'Agata","year":"2013","journal-title":"J Am Geriatr Soc"},{"issue":"10","key":"2020060309441619000_i2168-9709-10-2-55-b02","doi-asserted-by":"publisher","first-page":"e83","DOI":"10.1093\/cid\/ciy1121","article-title":"Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America","volume":"68","author":"Nicolle","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2020060309441619000_i2168-9709-10-2-55-b03","unstructured":"Bonkat\n G\n , PickardR, BartolettiR, BruyereF, GeerlingsSE, WagenlehnerF, et al. \n EAU guidelines on urological infections. Arnhem (the Netherlands): European Association of Urology Guidelines Office;2017. p. 1-64."},{"issue":"3","key":"2020060309441619000_i2168-9709-10-2-55-b04","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.jhin.2016.04.007","article-title":"Overtreatment of asymptomatic bacteriuria: a qualitative study","volume":"93","author":"Eyer","year":"2016","journal-title":"J Hosp Infect"},{"issue":"2","key":"2020060309441619000_i2168-9709-10-2-55-b05","doi-asserted-by":"publisher","first-page":"64","DOI":"10.9740\/mhc.2020.03.064","article-title":"Creation and implementation of a urinary tract infection diagnostic and treatment algorithm for psychiatric inpatients with a communication barrier","volume":"10","author":"Rarrick","year":"2020","journal-title":"Ment Health Clin [Internet]"},{"issue":"8","key":"2020060309441619000_i2168-9709-10-2-55-b06","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/j.ajic.2011.09.013","article-title":"Reduction in inappropriate prevention of urinary tract infections in long-term care facilities","volume":"40","author":"Rummukainen","year":"2012","journal-title":"Am J Infect Control"},{"issue":"1","key":"2020060309441619000_i2168-9709-10-2-55-b07","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.idc.2013.10.004","article-title":"Diagnosis and management of urinary tract infection in older adults","volume":"28","author":"Rowe","year":"2014","journal-title":"Infect Dis Clin North Am"},{"key":"2020060309441619000_i2168-9709-10-2-55-b08","first-page":"18","article-title":"Urinary incontinence","author":"Department of Health and Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS)","year":"2005","journal-title":"CMS Manual System Pub. 100-07 State Operations Provider Certifications Transmittal 8"},{"issue":"10","key":"2020060309441619000_i2168-9709-10-2-55-b09","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1086\/667743","article-title":"Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria","volume":"33","author":"Stone","year":"2012","journal-title":"Infect Control Hosp Epidemiol"}],"container-title":["Mental Health Clinician"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/10\/2\/55\/2458896\/mhc_2020_03_055.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/10\/2\/55\/2458896\/mhc_2020_03_055.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T16:19:08Z","timestamp":1731687548000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/10\/2\/article-p55.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,1]]},"references-count":9,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,3,1]]}},"URL":"https:\/\/doi.org\/10.9740\/mhc.2020.03.055","relation":{},"ISSN":["2168-9709"],"issn-type":[{"type":"electronic","value":"2168-9709"}],"subject":[],"published":{"date-parts":[[2020,3,1]]}}}